What is Health Insurance?

Health Insurance is an insurance plan that provides comprehensive coverage against medical expenses, hospital bills, and other costs related to medical treatments. It protects the insured person against the financial risks that come with an illness or accidental injury.


Multiple sum insured

Enjoy the flexibility to choose between two plan variants along with sum insured options ranging from Rs 1.5 lakh to Rs 50 lakh.

Convalescence benefit

You will be eligible for a benefit pay out of Rs 5,000 annually, in case of continuous hospitalisation for a period of 10 days or more and provided that your hospitalisation claim is admissible.

Sum insured reinstatement

If you completely exhaust your sum insured along with the cumulative bonus (if any) during the policy year, we will reinstate the same.

Covers road ambulance expenses

This policy covers ambulance expenses incurred up to Rs 20,000 incurred at the time of discharge.

Daily cash benefit

A daily cash benefit of Rs 500 per day, for up to 10 days, during each policy year is provided as accommodation expenses for one parent/legal guardian to stay with a minor insured under the policy, for an admissible claim.

Covers Ayurvedic and homoeopathic treatment

As per the Gold Plan of the policy, in-patient hospitalisation expenses up to Rs 20,000 incurred in a recognised Ayurvedic/homoeopathic hospital are covered if the admission period is not less than 24 hours.

Covers extended family

This policy covers extended family members including parents, in-laws and siblings, on an individual basis.

Covers day care procedures

This policy covers medical expenses incurred during the treatment of listed day care procedures or surgeries.

Bariatric surgery cover

Bariatric surgery is covered under medical advice, subject to certain terms and conditions; under the Gold Plan.

Covers pre and post hospitalisation

This policy covers pre and post hospitalisation expenses up to 60 days and 90 days respectively.

Covers organ donor expenses

This policy covers expenses towards organ donor’s treatment for harvesting of the donated organ.

Maternity/ new born baby cover

Under the Gold Plan, maternity expenses and medical expenses towards treatment of a new born baby is covered, subject to certain terms and conditions.

What factors determine my Health Insurance premium amount?

The Health Insurance premium amount mainly depends on the sum insured and the number of members covered under the Health Insurance policy. Here are a few other factors that determine your Health Insurance premium:

  • Your age
  • Pre-existing diseases
  • Add-on covers (optional)

Who can be covered under the Family Health Insurance policy?

Under the Family Floater Health Insurance plan, you can cover yourself, your spouse and up to 4 dependent children. For parents and in-laws, you can opt for a separate health insurance policy.

pre and post hospitalisation medical expenses that you cover.

Pre hospitalisation expense is as a result of tests, medication that would have to be undertaken prior to the hospitalisation for the treatment. Similarly, post hospitalisation expenses can be for recovery and medicines that need to be taken post the hospitalisation treatment. Pre and post hospitalisation are 60 and 90 days respectively.

When you fall sick, you usually consult your family physician and get relevant investigations done. On the advice of your physician, you get hospitalised for further treatment of the disease if required. These medical expenses incurred before hospitalisation are called pre hospitalisation expenses.

Post hospitalisation expenses include all expenses or charges incurred by you after you are discharged or after hospitalisation treatment is done. For example, the consulting physician may prescribe certain tests to ascertain your progress or recovery after surgery.

What is a ‘deductible’ in Health Insurance policy?

A deductible is a fixed amount that you have to pay at the time of claim that will not be reimbursed. At the time of settlement, we will pay the claim amount minus the deductible.

What does a day care medical treatment mean?

Day-care treatments are such medical procedures (surgeries or treatments) that can be completed in less than 24 hours. In such cases, even though you may be hospitalised, you don’t have to stay in the hospital for more than 24 hours.

Tell me about pre-existing diseases and waiting period.

Pre-existing diseases are those you may already know the existence of in your life before you buy a medical insurance policy. Hence, you must declare any pre-existing disease/condition at the time of buying a medical insurance plan.

One of the key factors to keep in mind is that the pre-existing diseases have a waiting period (which differs from company to company). Hence, by taking a policy at a young age you can only hope that by the time, and if you are diagnosed with a disease that falls under the pre-existing category, your waiting period will be complete. Also, you can ensure that you are eligible to avail full benefits of your medical insurance policy.

How can I save taxes with Health Insurance?

Bajaj Allianz General Insurance Health Insurance policy helps you save tax up to Rs 1 lakh under Section 80D against the premiums you pay. Here’s how you can save tax:

On the premiums you pay for yourself, your spouse, children and parents, you can avail Rs 25,000 per annum as a deduction against your taxes (provided you are not over 60 years). If you pay a premium for your parents who are senior citizens (age 60 or above), the maximum health insurance benefit for tax purposes is capped at Rs 50,000. As a taxpayer, you may, therefore, maximise tax benefit under Section 80D up to a total of Rs 75,000, if you are below 60 years of age and your parents are senior citizens. If you are above the age of 60 years and are paying a medical insurance premium for your parents, the maximum tax benefit under Section 80D is, then, Rs 1 lakh.

How much cover do I need?

Your coverage amount depends on your lifestyle, medical background, pre-existing diseases, members of your family, annual income, residential address and age.

What are the documents required while purchasing a Health Insurance plan?

For senior citizens, a medical check-up is required prior to buying insurance. A valid identity card, address proof, age proof and passport size photo are required for all policyholders.

Age proof: Birth certificate, Passport, Driver’s License, Voter ID card.

ID proof: Driving license, Passport, PAN card, Aadhaar card

Address proof: Electricity bill, Telephone bill, Ration card, Passport, Aadhaar card.

Can I cancel my Health Insurance policy?

Yes, you can cancel your Health Insurance policy. We provide a free period of 15 days from the date of policy issuance within that you can cancel the policy and avail a refund if you are not satisfied with it. However, your refund will be adjusted against any expenses incurred such as underwriting costs, medical check-ups and so on.

What happens to my policy after a claim is filed and settled?

After your claim is filed and settled, your insurance cover will be reduced by the amount that has already been paid to you. For example, if your policy was issued in January with a Rs 5 lakh coverage and if you claimed an amount of Rs 3 lakh in July, then a balance of Rs 2 lakh is available to you between August-December.

What are the modes available for the payment of premiums?

You can make the premium payment using the following modes:

  • Cheque or cash payment.
  • Online payment – Debit/credit card and net banking.

What is the difference between Health Insurance policy and Mediclaim policy?

Mediclaim policy only provides cover against hospitalisation and treatment expenses for a defined pre-specified illness as per the sum insured. Health Insurance policy covers pre and post hospitalisation expenses.


Reimbursement claim process (in case of a non-network hospital)

  • Inform the team about the hospitalisation for intimation.
  • After discharge, you or a family member must submit the following documents to the HAT within 30 days: Duly filled and signed claim form with mobile number and email ID. Original hospital bill and payment receipt. Investigation report Discharge card, Prescriptions Bills of medicines and surgical items Details of pre-hospitalization expenses (if any) In-patient papers, if required.
  • All documents to be sent to HAT for further processing and based on the assessment, the final settlement will be done within 10 working days.
  • Post hospitalisation claim documents must be sent within 90 days from the date of discharge.

Documents required for reimbursement claim:

  • Original pre-numbered hospital payment receipt duly sealed and signed.
  • Original prescriptions and pharmacy bills.
  • Original consultation papers (if any).
  • Original investigation and diagnostic reports along with original bills and payment receipt for the investigation done within and outside the hospital.
  • If you or a family member availed a cashless claim but did not utilise it, a letter from the hospital stating so.
  • A letter from the treating doctor mentioning incident details (in case of an accident).
  • Hospital registration certificate and hospital infrastructure on the letterhead.
  • A cancelled cheque bearing IFSC code and name of the insured.
  • Indoor case paper copy attested from the hospital from the date of admission to the date of discharge with detailed medical history and doctor’s notes with temperature, pulse and respiration charts.
  • X-ray films (in case of a fracture).
  • Obstetric history from treating doctor (in maternity cases).
  • FIR copy (in accident case).
  • Additional requirements for some special cases: In case of a cataract operation, lens sticker with a bill copy. In case of a surgery, implant sticker with a bill copy. In case of a heart-related treatment, stent sticker with a bill copy.

Cashless claim process (only applicable for treatment at a network hospital):

Cashless facility at network hospitals is available 24x7, throughout the year without any interruption in service. You must check the hospital list before getting admitted to the hospital. Hospitals that provide cashless settlement are liable to change their policy without notice. The updated list is available on our website and with our call centre. Bajaj Allianz Health Card along with a government ID proof is mandatory at the time of availing cashless facility.

When you are opting for cashless claims, the process is as follows:

  • Get the pre-authorisation request form filled and signed by the treating doctor/hospital and signed by you or a family member, at the hospital’s insurance desk.
  • The network hospital will fax the request to HAT.
  • HAT doctors will examine the pre-authorisation request form and decide on cashless availability, as per the policy guidelines.
  • Authorisation letter/denial letter/additional requirement letter is issued within 3 hours depending on the plan and its benefits.
  • At the time of discharge, the hospital will share the final bill and discharge details with HAT and based on their assessment, final settlement will be processed.

Important points to note:

  • In case of planned hospitalisation, register/reserve your admission as per the network hospital’s procedure for admission in advance.
  • Admission at network hospital is subject to availability of a bed.
  • Cashless facility is always subject to your policy terms and conditions.
  • The policy does not cover the following: Telephone charge, and beverages for relatives Toiletries The cost of the above services have to be borne by you and paid directly to the hospital before discharge.
  • In-room rent nursing charges are included. However, if a higher cost room is used then the incremental charges will be borne by you.
  • In case the treatment is not covered as per the policy terms and conditions, your claim-cashless or reimbursement, will be denied.
  • In case of inadequate medical information, pre authorisation for cashless claim can be denied.
  • The denial of cashless facility does not mean denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalisation.